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Benjamin P. Saylor is associate editor of Urology Times, an Advanstar Communications publication.

According to the authors, these data support the ongoing investigation of zanzalintinib in combination with immune checkpoint inhibitors.

Zanzalintinib plus nivolumab shows promising clinical activity in ccRCC

“AMPLITUDE supports early genomic testing and niraparib plus AAP as a new treatment option for patients with mCSPC and HRR gene alterations," the authors wrote.

Adding niraparib to AAP extends rPFS in HRR-positive mCSPC

Treatment with darolutamide was found to extend median time to deterioration of FACT-P total score by 5.1 months vs placebo

ARANOTE: Darolutamide improves HRQoL in mHSPC

“This was a positive study, resulting in a statistically significant improvement in the primary end point of rPFS in the intent-to-treat population," said Rana R. McKay, MD, FASCO.

COMRADE: Olaparib plus radium-223 improves rPFS in mCRPC

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Schaeffer is a professor of urology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Learning curve for technique is short, but capital expenditures are required.

Moving transperineal prostate biopsy into the clinic

Dr. De La Cerda provides an overview of a patient case involving a 68 year-old male presenting with severe back pain, with an analysis of the clinical presentation, workup, and medical history.

Bone Predominant mCRPC Patient Case

Video content above is prompted by the following:

What are your initial impressions of the case?

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The FDA has accepted a Biologics License Application (BLA) seeking approval of nivolumab (Opdivo) co-formulated with Halozyme’s proprietary recombinant human hyaluronidase (rHuPH20), or subcutaneous nivolumab, for the treatment of patients with all previously approved solid tumor indications for nivolumab as a monotherapy, monotherapy maintenance following completion of combination therapy with nivolumab plus ipilimumab (Yervoy), or in combination with chemotherapy or cabozantinib (Cabometyx).

Nivolumab is currently approved under several indications, including in combination with ipilimumab for the first-line treatment of patients with intermediate- or poor-risk advanced renal cell carcinoma (RCC), in combination with cabozantinib for the first-line treatment of patients with advanced RCC, for the treatment of patients with advanced RCC who have received prior anti-angiogenic therapy, and in combination with cisplatin and gemcitabine for the first-line treatment of patients with unresectable or metastatic urothelial carcinoma.

The FDA is set to have a decision regarding the subcutaneous nivolumab formulation on or by December 29, 2024.

 According to a news release from Bristol Myers Squibb,

 approval of the formulation would make it the first and only subcutaneously administered PD-1 inhibitor.

“We believe subcutaneous nivolumab has the potential to make a significant difference in the lives of patients, which is reinforced by the FDA’s acceptance of our application,” said Gina Fusaro, PhD, vice president, global program lead, Bristol Myers Squibb, in the news release.

 “Opdivo is a foundational PD-1 inhibitor approved for many different types of cancer, and our continued investment in research that puts patients first remains a priority. If approved by the FDA, the subcutaneous administration of nivolumab would provide patients and their physicians with a new option that delivers the same well-known benefits as IV Opdivo but with the improved convenience of an injection administered in 3 to 5 minutes rather than a 30-to-60-minute infusion.”

The BLA submission is supported by findings from the phase 3 CheckMate-67T trial (NCT04810078), in which subcutaneous nivolumab met the study’s co-primary end points by demonstrating noninferiority to intravenous (IV) nivolumab regarding time average nivolumab serum concentration over 28 days (C

; geometric mean ratio [GMR}, 2.098; 90% CI, 2.001-2.200) and minimum serum concentration at a steady state (C

Data from the study, which were presented at the 2024 American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco, California,

 also showed that subcutaneous nivolumab demonstrated noninferiority to IV nivolumab in the key powered secondary end point of objective response rate (ORR). Specifically, the subcutaneous arm demonstrated an ORR of 24.2% (95% CI, 19.0-30.0) per blinded independent central review (BICR), compared with 18.2% (95% CI, 13.6-23.6) in the IV arm.

The safety profile for subcutaneous nivolumab was consistent with that of the IV formulation. Among patients who received the subcutaneous formulation, 8.1% experienced injection-site reactions, with all being low-grade and transient. Deaths due to study drug toxicity occurred in 3 patients in the subcutaneous arm and 1 patient in the IV arm. Most deaths that occurred during the study were due to disease progression.

In total, the phase 3, open-label CheckMate-67T trial enrolled 495 patients with advanced or metastatic ccRCC who had received prior systemic therapy. Patients were randomly assigned 1:1 to receive 1200 mg subcutaneous nivolumab plus rHuPH20 every 4 weeks (n = 248) or to 3 mg/kg IV nivolumab every 2 weeks (n = 247) for up to 2 years of treatment or until disease progression, unacceptable toxicity, withdrawal, or death.

The co-primary pharmacokinetic end points for noninferiority testing were C

 of subcutaneous nivolumab vs IV nivolumab. The key secondary end point was ORR per BICR.

Final completion of the CheckMate-67T study is expected in January 2026.

1. U.S. Food and Drug Administration accepts Bristol Myers Squibb’s application for subcutaneous nivolumab (nivolumab and hyaluronidase). News release. Bristol Myers Squibb. May 6, 2024. Accessed May 7, 2024. https://news.bms.com/news/corporate-financial/2024/U.S.-Food-and-Drug-Administration-Accepts-Bristol-Myers-Squibbs-Application-for-Subcutaneous-Nivolumab-nivolumab-and-hyaluronidase/default.aspx

2. Bristol Myers Squibb announces updated action date by the U.S. Food and Drug Administration for subcutaneous nivolumab (nivolumab and hyaluronidase). News release. Published online and accessed May 21, 2024. https://investors.bms.com/iframes/press-releases/press-release-details/2024/Bristol-Myers-Squibb-Announces-Updated-Action-Date-by-the-U.S.-Food-and-Drug-Administration-for-Subcutaneous-Nivolumab-nivolumab-and-hyaluronidase/default.aspx

3. George S, Bourlon TB, Chacon MR, et al. Subcutaneous nivolumab (NIVO SC) vs intravenous nivolumab (NIVO IV) in patients with previously treated advanced or metastatic clear cell renal cell carcinoma (ccRCC): Pharmacokinetics (PK), efficacy, and safety results from CheckMate 67T. 

4. A study of subcutaneous nivolumab versus intravenous nivolumab in participants with previously treated clear cell renal cell carcinoma that is advanced or has spread (CheckMate-67T). ClinicalTrials.gov. Last updated March 1, 2024. Accessed May 7, 2024. https://clinicaltrials.gov/study/NCT04810078

The FDA is set to have a decision regarding the subcutaneous nivolumab formulation on or by December 29, 2024. 

News

FDA accepts BLA for subcutaneous nivolumab in solid tumors

 suggest that the use of combination therapy in veterans with de novo metastatic-hormone sensitive prostate cancer (mHSPC) has increased over time and is associated with significantly longer overall survival (OS) vs androgen-deprivation therapy (ADT) monotherapy.

"Frequently new drugs work [well] in clinical trials and have little effect in the real world. In most clinical trials patients are younger (age 65-70) and predominantly White (<4% Black men) who can travel to high-end academic medical centers and are more physically fit," explained lead author Martin W. Schoen, MD, MPH, of Saint Louis University and St. Louis Veterans Affairs Medical Center, in correspondence with 

. "Our data comes from the entire VA, which includes ~25% Black men and men who are age 70-75 with heart disease, diabetes, etc. We show that in a real world population, the new therapies are effective. This study shows that the benefits of therapies in clinical trials is translating to benefits in the real world in a large group of patients."

In total, the retrospective cross-sectional study assessed 6216 veterans who received a diagnosis of de novo mHSPC from January 2013 to December 2022. The mean age of patients was 73.9 years (SD, 9.7). Among the 6216 patients included in the analysis, 3839 (61.8%) received ADT monotherapy, 1719 (27.7%) received an ARPI combination, and 658 (10.6%) received a docetaxel combination.

Overall, data showed an increase in the use of combination therapy over time, with combination treatment with either an ARPI or docetaxel becoming the majority of treatment in 2020. In 2020, combination therapy was used in 54% of patients (344 of 637), which rose to 63.1% of patients (465 of 737) in 2022.

Combination therapy was also associated with a significantly longer OS vs ADT monotherapy. Specifically, the mean OS was 40.3 months with combination therapy compared with 33 months with ADT monotherapy (HR, 0.80; 95% CI, 0.74 to 0.87).

There was no difference in OS between ARPI-based and docetaxel-based combination regimens. The mean OS was 40.4 months with ARPI combination therapy vs 40.2 months with docetaxel combination therapy (HR, 1.06; 95% CI, 0.92 to 1.22).

The study also assessed outcomes among 1540 patients who received combination therapy and had imaging reports for volume of disease. Those with high-volume disease demonstrated a significantly shorter survival; the mean OS was 33.3 months among those with high-volume disease compared with 62.5 months among those with low-volume disease (HR, 0.51; 95% CI, 0.43 to 0.60; 

Patients with high-volume disease were also more likely to receive combination therapy with docetaxel. Overall, 33.8% of patients with high-volume disease received docetaxel combination therapy vs 22.1% of patients with low-volume disease (

In patients with high-volume disease, data showed no difference in OS between those who received an ARPI combination vs those who received a docetaxel combination. Specifically, OS was 32.2 months among those who received an ARPI combination vs 34.7 months among those who received a docetaxel combination (HR, 1.06; 95% CI, 0.91 to 1.23).

However, in those with high-volume disease, combination therapy with an ARPI was associated with a longer progression-free survival (PFS) vs combination therapy with docetaxel. The mean PFS was 18.7 months with an ARPI combination vs 16.0 months with a docetaxel combination (HR, 0.80; 95% CI, 0.70 to 0.91).

Trends were similar in patients with low-volume disease. Data showed no difference in OS between those who received an ARPI vs docetaxel regimen (68.4 months vs 55.3 months; HR, 0.81; 95% CI, 0.58 to 1.13), but PFS was significantly longer among those who received an ARPI regimen. Specifically, the mean PFS was 39.7 months in those who received an ARPI combination vs 24.0 months in those who received a docetaxel regimen (HR, 0.57; 95% CI, 0.43 to 0.76).

"This research shows that these drugs have a dramatic effect on average patients in the VA, a group that is hard to treat," Schoen added. "This is the first large study that I am aware of that has compared chemotherapy vs hormonal therapies in matched patients in routine clinical practice."

The authors also concluded, “The data presented here suggest that an ARPI doublet combination treatment that avoids chemotherapy is a standard of care, and there is little evidence of benefit associated with a docetaxel doublet compared with an ARPI doublet."

“Future research into the role of docetaxel in triple combination is needed to elucidate the benefit of chemotherapy in mHSPC," they added.

1. Schoen MW, Doherty J, Eaton D, et al. Treatment patterns and survival among veterans with de novo metastatic hormone-sensitive prostate cancer. 

. 2025;8(5):e259433. doi:10.1001/jamanetworkopen.2025.9433

2. Treatment patterns, survival among veterans with de novo metastatic hormone-sensitive prostate cancer. News release. Saint Louis University. May 7, 2025. Accessed May 27, 2025. https://www.newswise.com/articles/treatment-patterns-survival-among-veterans-with-de-novo-metastatic-hormone-sensitive-prostate-cancer

Combination therapy for veterans with de novo metastatic hormone-sensitive prostate cancer (mHSPC) has increased over time, leading to significantly longer overall survival (OS) compared to androgen-deprivation therapy (ADT) monotherapy. The study analyzed 6216 veterans, revealing that combination therapy became predominant by 2020. No OS difference was found between androgen receptor pathway inhibitors (ARPI) and docetaxel combinations, but ARPI showed longer progression-free survival (PFS). High-volume disease patients had shorter OS, with docetaxel more frequently used. Future research is needed to explore docetaxel's role in triple combination therapies.

However, the data did not show any benefit of a docetaxel doublet vs an ARPI doublet.

Combination therapy linked to longer OS vs ADT in veterans with mHSPC

Click the image or this link to access the survey results

Open the survey by clicking the image or link above. It will open the interactive publication in a new browser window.

Arrows on both sides of the screen allow you to navigate from page to page. 

There are buttons on the bottom-right of your screen to display thumbnails of all the pages beneath the viewer, or to zoom in/out, or make full screen.

When you come across video content, you can click to watch within the publication.

For now, the survey link performs better for desktop/laptop viewing. You can view on mobile but some interactive experiences may not be available.

Please reach out to Assistant Managing Editor Ben Saylor.

Co–Editor in Chief Michael S. Cookson, MD, MMHC, FACS, the survey polled urologists regarding treatment patterns and preferences in non­–muscle invasive bladder cancer.

In the article accompanying the results, Cookson, along with 

Clinical Practice Board member Jason M. Hafron, MD, provide insights on the survey data.

Also included are exclusive interviews with Mary Beth Westerman, MD, and Rebecca A. Campbell, MD, who each provide expert commentary on the survey's contents. 

The survey, developed by Urology Times Co–Editor in Chief Michael S. Cookson, MD, MMHC, FACS, explores treatment patterns and preferences among urologists for non–muscle invasive bladder cancer. Insights on the survey data are provided by Cookson and Urology Times Editorial Council member Jason M. Hafron, MD. Additionally, the survey includes an exclusive interview with Mary Beth Westerman, MD, offering expert commentary on the findings. The interactive publication is best viewed on desktop/laptop for optimal experience, with video content accessible within the publication.

Results of an exclusive Urology Times survey point to urologists preferring intravesical chemotherapy for treating BCG-unresponsive NMIBC.

Survey: New NMIBC treatments face slow uptake

IsoPSA demonstrated comparable or superior diagnostic performance in Black and non-White men, underscoring its clinical utility in the detection of clinically significant prostate cancer across racial groups.

2025 American Urological Association (AUA) Annual Meeting

 in Las Vegas, Nevada. In a recent interview with 

, detailed the background and key findings from the study.

He explained, “We thought that any test that is on the market that might help physicians decide whether or not to treat, biopsy, [or] diagnose prostate cancer, it's important to know whether or not it performs similarly across racial backgrounds. That was the impetus for this study, was to try to figure out whether or not there are racial disparities with how this test performs, or if this has actual, real generalizability across different patient groups.”

Scovell is a urology resident at Cleveland Clinic in Cleveland, Ohio.

Jason M. Scovell, MD, detailed the background and key findings from a study of IsoPSA across racial groups. 

Jason Scovell, MD, on clinical utility of IsoPSA across racial groups

In total, the study included 871 patients, of whom 770 were White, 85 were Black, and 101 were Non-White.

Data showed that when using an IsoPSA cutoff of 6, the negative predictive value exceeded 90% across all racial groups. The authors also reported, “Positive predictive value and area under the curve were higher for Black and Non-White patients compared [with] White patients.”

Based on these data, Scovell concluded, “I would be hesitant to say that it performed better. I think we need to have prospective studies to make those kinds of claims, but I do think this gives us a lot of reassurance that this is probably performing at least on par across these racial backgrounds in our cohort.”

1. Haile ES, Scovell JM, Weight CJ, et al. IsoPSA and race: Improved diagnostic accuracy for Black and non-White men in prostate cancer detection. 

. 2025;213(5S):e1290. doi:10.1097/01.JU.0001110172.53107.6f.17

The test demonstrated comparable or superior performance in Black and Non-White men.

Findings from the phase 3 CREST (NCT04165317) study indicate significantly prolonged event-free survival (EFS) with sasanlimab plus BCG compared with BCG alone in patients with high-risk non–muscle invasive bladder cancer (NMIBC).

Neal D. Shore, MD, FACS, director of the Carolina Urologic Research Center in Myrtle Beach, South Carolina, presented the data during a plenary session at the 

“The [mechanism of action] for combining BCG with a PD-1 blocker has been well established up-regulating PD, and therefore the synergistic effect of adding a PD blocker. Of note, sasanlimab is delivered subcutaneously, which may be actually very advantageous for certain clinics, both [medical oncology] and [urology].”

The CREST study included 1055 patients with BCG-naïve, high-risk NMIBC that is high-grade Ta and/or carcinoma in situ (CIS) and had not received prior PD-(L)1, PD-L2, or CTLA-4 inhibitors or immunostimulatory agents. They were randomly assigned 1:1:1 to arm A (sasanlimab plus BCG induction and maintenance), arm B (sasanlimab plus BCG induction), and arm C (BCG induction plus maintenance). The primary end point was EFS for arm A vs arm C. Key secondary end points included EFS in arm B vs arm C, and overall survival (OS). Select secondary end points included complete response (CR) in patients with CIS, duration of CR in patients with CIS, safety, and quality of life.

A total of 352 patients were included in arm A and 351 were included in arm C. Median patient age was 67 years in both arms. A total of 280 (79.5%) and 284 (80.9%) patients were male in arms A and C, respectively. A total of 225 (63.9%) and 210 (59.8%) of patients were Caucasian in arms A and C, respectively, and 115 (32.7%) and 126 (35.9%) were Asian.

Regarding disease stage, “55% or higher were T1 patients. Twenty-five percent of this population was CIS, of which 15% was strictly CIS by itself. Looking at the patients and their maintenance of similar rates of BCG, if you look at the discontinuation rates, they're relatively comparable in the combination arm and the BCG arm. What that tells me is that adding sasanlimab did not impact the ability to deliver induction and maintenance BCG,” Shore said.

Shore reported that the risk of experiencing an EFS event was 32% lower in arm A vs arm C (HR=0.68; 95% CI: 0.49-0.94, 1-sided 

value=.0095). Recurrence of high-grade disease was observed in 26 (7.4%) patients in arm A vs 53 (15.1%) patients in arm C. Persistence of CIS was seen in 1 (0.3%) patient in each arm.

EFS was not found to be different between arm B and arm C. “The take-home for this is that BCG maintenance is effective and does matter,” Shore said. He also reported no meaningful difference between treatment arms when it came to interim OS.

Shore also highlighted CR and duration of response in patients with CIS. “In the patients with CIS, the probability of a continued complete response at 36 months was 92% vs 67.7%. I think that's a rather compelling finding,” Shore said.

In terms of adverse events, the safety profile was reported to be consistent with the known safety profile for each agent.

“We didn't find anything that we hadn't anticipated for this class of therapies, whether it was BCG or a checkpoint inhibitor,” Shore said.

In addition, quality of life was maintained for patients receiving sasanlimab in combination with BCG induction plus maintenance.

“In conclusion, this is the first [of 4 large phase 3 trials evaluating checkpoint blockade in BCG-naïve patients] to show and report here at the AUA 2025…a statistically significant prolongation of EFS with sasanlimab in combination with BCG. [In] patients with CIS the probability of continued CR was greater for the combination—92% vs 68% at 36 months. The safety profile was as expected. I think it's important to recognize the unique subcutaneous administration, and very importantly, that we will need continued collaborative, multi-disciplinary efforts to make sure and optimize shared decision-making for patients who are at risk,” Shore concluded.

In a news release about the results, Megan O’Meara, MD, Interim Chief Development Officer of Pfizer Oncology commented, “Today’s pivotal phase 3 CREST results offer a much-needed therapeutic breakthrough and spotlight sasanlimab as the first immunotherapy combination with BCG to significantly improve outcomes for patients with BCG-naïve, high-risk NMIBC in over three decades. The CREST findings are especially impactful for these patients with early-stage cancer who may benefit the most from innovative treatment regimens, including a subcutaneous immune checkpoint inhibitor, that delay disease recurrence or progression. These results underscore our long-standing commitment to patients with bladder cancer across all stages of the disease. We look forward to working with global regulatory authorities to potentially bring sasanlimab as an important new treatment option to patients with high-risk NMIBC.”

1. Shore ND, Powles T, Bedke J, et al. Sasanlimab in combination with Bacillus Calmette-Guérin improves event-free survival versus Bacillus Calmette Guérin as standard of care in high-risk non-muscle invasive bladder cancer: Phase 3 CREST study results. 

2. Pfizer’s sasanlimab combination significantly improves event-free survival in BCG-naïve, high-risk non-muscle invasive bladder cancer. News release. Pfizer. April 26, 2025. Accessed April 26, 2025. https://www.pfizer.com/news/press-release/press-release-detail/pfizers-sasanlimab-combination-significantly-improves-event

The phase 3 CREST study demonstrated that sasanlimab combined with BCG significantly prolongs event-free survival (EFS) compared to BCG alone in patients with high-risk non-muscle invasive bladder cancer (NMIBC). The study involved 1055 BCG-naïve patients, with a primary focus on EFS between treatment arms. Results showed a 32% lower risk of EFS events in the combination arm. Complete response rates in patients with carcinoma in situ (CIS) were notably higher with the combination therapy. The safety profile was consistent with known data, and quality of life was maintained.

“In the patients with CIS, the probability of a continued complete response at 36 months was 92% vs 67.7%," said Neal D. Shore, MD, FACS. 

Edward M. Schaeffer, MD, PhD

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